■ Tobacco brand placement has declined due partly to a settlement with the major tobacco companies, but alcohol placement is subject only to self-regulation.

Few parents or physicians realize how many alcohol references youths are exposed to when they watch a movie that is rated PG or PG-13, said researcher Elaina Bergamini.

About 145 alcohol brands appeared in youth-rated movies that were among the top 100 box office hits in 2009, said Bergamini, who co-wrote a study on the subject. The findings were published online May 27 in JAMA Pediatrics, formerly Archives of Pediatrics & Adolescent Medicine.

In 1996, there were about 80 alcohol brand appearances in PG and PG-13 films that were among that year's 100 biggest hits, the study said.

Researchers said it's unclear why there has been an increase of alcohol on the silver screen.

“There's a lot of drinking in the movies, and that drinking rarely is associated with a negative consequence,” said Bergamini, a content coding supervisor at the Geisel School of Medicine at Dartmouth College in New Hampshire.

That trend poses a significant health concern because “evidence is accumulating that movies influence substance use behaviors during adolescence,” the study authors wrote.

Bergamini encourages physicians to alert young patients and their parents about the prevalence of alcohol in movies aimed at the youth market. She said doctors also should recommend that parents have open conversations with their children about what they see in films, including drinking and tobacco products.

While alcohol in films increased, tobacco product placement decreased most years from 1996 to 2009 until leveling off at 22 appearances in 2006. The length of smoking scenes in movies also dropped during the study period.

Likely contributing to that change is the 1998 Master Settlement Agreement, in which the major tobacco companies agreed to end product placements of their brands in film or television, the study said. In 2011, the American Medical Association issued a statement saying it was pleased with efforts to remove smoking from youth-rated films.

Alcohol brand placement in movies has been subject only to self-regulation, the study authors said.

The study shows that “to be effective, constraints on advertising for products that harm adolescents should be externally developed and enforced,” said James D. Sargent, MD, co-author of the study and professor of pediatrics and community and family medicine at the Geisel School of Medicine. “Historically, industry self-regulation in this area does not work.”

Rating change sought to include alcohol

DID YOU KNOW: More than 60% of alcohol appearances in movies are in films aimed at the youth market.

For the JAMA Pediatrics study, two researchers viewed theater versions of the 100 movies with the highest U.S. box-office gross revenues for each year from 1996-2009. They recorded the duration of alcohol and tobacco use, and presence of alcohol and tobacco brands in each film.

Tobacco use was measured by the number of seconds the product was used or handled on-screen. Use of alcohol was assessed by the seconds of real or implied use of an alcoholic beverage, including the purchase of such a product. Brand appearances were defined as any appearance of a particular brand, recognizable logo or trademark and any verbal mention of a brand.

Of the 1,400 movies examined, 64.7% were rated for youth (G, PG and PG-13) and 35.3% were intended for adults (R-rated). Overall, the films contained 500 tobacco and 2,433 alcohol brand appearances.

The study found that 62.8% of alcohol brand appearances occurred in films aimed at the youth market, as did 46.2% of tobacco brand appearances.

While there was a small decrease in minutes of on-screen alcohol use in adult-rated movies during the study period, no change was seen in movies for youths. The researchers did not identify why alcohol appears so frequently in movies geared toward children and adolescents.

“We don't know whether or not [the Motion Picture Assn. of America] uses the appearance of alcohol in the movies when considering the ratings,” Bergamini said. “But it's our opinion that they should.”

The Motion Picture Assn. of America declined to comment on the study.

The study calls for the association to amend its rating system so that any movie exhibiting alcohol abuse, binge drinking, drinking and driving, or underage drinking receive an R rating.

The study authors also said payments should not be made for alcohol placements in films and TV shows geared toward youths. If such transactions do occur, the amount paid and the film or show in which the product is placed should be publicized, the study said.

ADDITIONAL INFORMATION

Tobacco and alcohol brands that loom large in films

Data show that movies can influence substance use behaviors among adolescents. Here are the five most common alcohol and tobacco brands that appeared in 1,400 films released in the U.S. between 1996 and 2009. Percentages refer to how often a product was seen among 500 tobacco appearances and more than 2,400 alcohol appearances.

Alcohol

Budweiser: 17.7%Miller: 10.7%Heineken: 5.0%Coors: 2.8%Corona: 2.3%

Tobacco

Marlboro: 33.4%Camel: 10.0%Kool: 5.8%Winston: 4.8%Newport: 4.4%

Source: “Trends in Tobacco and Alcohol Brand Placements in Popular U.S. Movies, 1996 Through 2009,” JAMA Pediatrics, formerly Archives of Pediatrics & Adolescent Medicine, published online May 27 (link)